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Can you pass the smell test? If not, you may be at risk for Parkinson’s says scientist working for earlier diagnosis

The sense of smell may erode years before Parkinson's is diagnosed. / Palm Beach Post

About half a million people in the United States have a Parkinson’s diagnosis.

But many more people may have an earlier stage of the disease. Identifying those people before they develop tremors would make a world of difference, said Dr. Matthew Stern.

Stern, director of the University of Pennsylvania’s Parkinson’s Disease and Movement Disorders Center, spoke in Palm Beach on Monday at “Shades of Gray: A Symposium on Aging” sponsored by MorseLife, the non-profit retirement care company based out of West Palm Beach.

Dr. Matthew B. Stern / University of Pennsylvania

There are several markers that can be seen years before a patient develops the frozen facial features, the jerking limbs, the stooped posture and shuffling gate associated with Parkinson’s, Stern said.
Some of these markers can be seen in spinal fluid, others in brain scans.

But one of the most unusual and possibly easiest symptoms to test for is an inability to distinguish odors, Stern said.

People about to develop Parkinson’s frequently cannot pass a smell test, he said.

“Most Parkinson’s patients have a profound loss of sense of smell, and they may not notice it,” Stern said. “It turns out the olfactory bulb may be a very early target for the disease.”

Stern said he’s now studying first-degree relatives of people with Parkinson’s. Out of 6,852 participants, 450 of them had difficulty smelling. He’s now following that subset.

He found they were more likely to have other features seen with Parkinson’s such as constipation and depression. It appears those who will develop Parkinson’s may lose the ability to distinguish odors three or four years before more obvious symptoms like tremors appear.

According to the National Institute of Neurological Disorders and Stroke, part of the NIH, there are options for treatment to address Parkinson’s symptoms, but not its causes:

“When symptoms grow severe, doctors usually prescribe levodopa (L-dopa), which helps replace the brain’s dopamine. Sometimes doctors prescribe other drugs that affect dopamine levels in the brain. In patients who are very severely affected, a kind of brain surgery known as pallidotomy has reportedly been effective in reducing symptoms. Another kind of brain surgery, in which healthy dopamine-producing tissue is transplanted into the brain, is also being tested.’

When medication fails, deep brain stimulation can be tried.
Other types of drugs are under study, including a calcium channel blocking drug called isradipine.

Parkinson’s generally is not diagnosed until tremors develop in a person’s arm, hand or leg. It’s average age of onset is 60. It worsens over time, and unfortunately, there is no cure.

Diagnosing it earlier is an important goal, he said.

“By the time we make a diagnosis, significant changes in the brain can be seen,” Stern said. “A very simple smell test may tell us who is more at risk.”